Tag: Marketisation

WORKING FOR PATIENTS OR NOT? – a guest post by Suzanne Kelsey

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A guest post by Suzanne Kelsey, who is a key campaigner for the NHS, amongst other things.

In 1988, when Margaret Thatcher had been in office for some 9 years, and the very foundations of our NHS had been shaken with more of the public encouraged to use private medical care,  there were serious concerns about capacity in the hospital services as waiting lists increased and wards closed.  The Conservative government appointed a group of people, without consulting the health professions, to look at this growing problem.

As a result of this the NHS experienced the most significant cultural shift since its inception with a White Paper entitled, ‘Working for Patients, ’ which proposed what we now  know as the ‘Internal Market’ and the development of the purchase provider split. GPs become the purchaser and the hospitals are the providers. This passed into law as the NHS and Community Care Act 1990. Understandably there was a great deal of opposition from trade unions, Labour and the general public but it went ahead as did the Private Finance Initiative in 1992 implemented for the first time in the UK by the Conservative government of John Major.

There is no doubt that further major problems were created for our NHS, although I would question if on the same scale as we are currently witnessing with the threat of complete privatisation and the sell-off of our publically funded service to huge private international companies, who have been waiting in the wings for quite some time and would have been rubbing their hands in glee some years ago if Thatcher and the Conservatives had continued in office.

The definition of ‘privatisation’ also needs to be acknowledged because with the downgrading of facilities and existing provision struggling to meet demands, more and more people will become anxious and tempted to pay for their treatment even if it is to ensure they have a hospital bed!

We must never let this practice become the ‘norm.’ Campaigners must ensure that the ‘free at point of use’ core principle is upheld or we will be taken back to pre-war years, removing freedom from fear that was fought long and hard for by our champions of social justice. At the same time we must remember the mantra, ‘public health not private wealth’ with numerous examples available to us of how private companies will always put profits before patients, but more of that later.

When Tony Blair became Prime Minister in 1997 he inherited a very impoverished NHS and although we expected him to abolish the internal market this did not happen, perhaps for a variety of justifiable reasons. How do you replace crumbling hospitals and inadequate resources without massively raising taxes, whilst also limiting the upheaval that had already been caused?

Alan Milburn was Minister of State at the Department of Health during this time and he stated that after years of the Tory’s gross underfunding, there was absolutely no money to fund the infrastructure, hence the use of John Major’s PFI initiative. Labour therefore it would seem had little choice but to implement this because of the historic neglect of the NHS under the Conservatives that led to understaffing and an NHS unable to manage with the rising expectations of the population, coupled with the costly advances in modern medicine and technology.

A global recession, which was not Labour’s fault, further compounded the challenges of meeting the complex needs of the nation’s health care. Dennis Skinner MP for Bolsover Derbyshire, passionately summarised this in parliament in 2014 when he stated; ‘Between 1997 and 2010 Labour dragged the NHS from the depths of degradation that the Tories had left it in and hoisted it back to the pinnacles of achievement.’

I would like to pose some questions to those experts of marketisation and competition. My knowledge is very limited on the economic implications but I am learning, slowly but surely, through my long involvement with local and national campaigning, speaking to key people in politics and campaign groups, who are also passionate about our NHS. I become increasingly frustrated when people continually blame Labour for the introduction of privatisation  Yes Blair did carry on certain aspects of it which was a disappointment for many, including me, but perhaps my arguments surely go some way to addressing why this was.

  •  My first question is in the title of this article; ‘IS THIS WORKNG FOR PATIENTS OR NOT?’
  •  If Labour had made such massive inroads into privatisation surely there would have been no need for the Coalition’s unwieldy and costly three billion pound reforms, so huge they were just about visible from outer space and the truth is many of those who voted for it would not have time to read it fully. The bill was a long time in the writing and despite the pause because of massive opposition it was nevertheless hastily introduced by the Coalition, despite all the election promises, notably, ‘there will be no top down reorganisation of the NHS.’ They have as predicted caused unprecedented chaos and in fact a major crisis in our NHS, with exhausted frontline workers propping up a system, becoming totally stressed, angry and demoralised.

Many of the population are afraid of becoming ill, because of worrying inadequacies not only at primary and secondary health care levels but also in social care. The frail and elderly feel a burden as they are constantly labelled as ‘bed blockers,’ Thus long queues have been created to see your GP and at A+E, the gateway to the hospital, all of which can result in a lack of timely care. In contrast however Labour ensured patient satisfaction was at its highest with waiting times were at their lowest and the NHS during their time was lauded as one of the best, if not the best health service in the world.

  • Were the massive and unprecedented reforms therefore unnecessary and unjustified?
  • What are the implications for binding private contracts that have taken place across large swathes of the country if hopefully there is a change of government?
  • What lesson have been learnt from the withdrawal of Circle, the private company that took over Hitchingbrooke hospital, with claims of managers installed by these private operators creating a ‘blame culture?’ Allegedly Circle were willing to ensure local GPs incurred financial losses as long as it meant corporations continued to make a profit and the damning report about the quality of care in this hospital is shocking. CQC inspecting the hospital felt obliged to intervene when they became fearful of a sickening child and Professor Mike Richards the chief inspector of hospitals said that the findings were the worst it had ever published.
  • Clive Efford Labour MP for Eltham, South East London,   presented a private members bill to parliament in November 2014,which in order to avoid further top down reorganisation, focussed on the most damaging aspects of the Health and Social Care Act 2012, that gave powers to competition regulators to interfere in decisions of local health care commissioners. The most significant change is that the Secretary of State is once again accountable to you and me through parliament. If the bill is passed he can no longer avoid answering parliamentary questions by saying that it is down to local decision making and not his responsibility. Efford’s Bill also provides that neither EU competition rules nor EU procurement rules will apply. That is an important change from the present because, at the moment, a disappointed private provider can sue an NHS commissioner for damages for failing to put a service out to tender or running a tender process wrongly. My thanks to Clive Efford for that explanation and for securing a vote of 241 for the bill to 18 against.
  • How is this Bill progressing and how it is being supported by NHS campaign groups and health professionals.
  • If the Conservatives are allowed to waltz back in by a public who have been influenced by the hype and propaganda through a biased media and/or have become disengaged, disenchanted or disillusioned , or indeed confused by the outrageous claims of some minor parties who seem to be making it up as they go along, what do we do next!?

I hear talk of a revolution being the only answer from those extremists who are likely to be the least affected by one. Perhaps we would do well to remember that our NHS has just seen the biggest revolution since its inception in 1948. Unfortunately we have seen a glimpse into our future and the outcomes are dire, if we do not use our votes wisely.

Suzanne Kelsey 1stFebruary 2015

http://www.nhshistory.net/shorthistory.htm#_ednref15

http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx

https://abetternhs.wordpress.com/2011/01/18/commissioning-and-the-purchaser-provider-split/

http://www.healthp.org/node/71

http://labourlist.org/2014/11/commons-pass-vote-on-clive-effords-nhs-bill/

http://www.telegraph.co.uk/news/politics/11333986/Damning-report-as-first-private-firm-to-run-NHS-hospital-pulls-out.html

Battle with GPs led to Circle’s retreat from Hinchingbrooke hospital,   The Guardian, January 9, 2015

Hinchingbrooke staff in CQC abuse concerns fear bosses BBC, September 29, 2014

http://www.independent.co.uk/news/uk/uks-healthcare-ranked-the-best-out-of-11-western-countries-with-us-coming-last-9542833.html

Labour MPs speak out against the TTIP and investigation opens into the impacts on environmental protections

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The impact of the controversial Transatlantic Trade and Investment Partnership trade deal on environmental protections in Europe is to be investigated by parliament. Opposition MPs will examine if the agreement could weaken regulations on chemical and pesticide use, oil and gas extraction and genetically modified food.

The Transatlantic Trade and Investment Partnership (TTIP) is a planned free trade agreement between the European Union and the US. Those who support it claim that it will “boost” economies. However there have been many concerns raised regarding this agreement. Critics say that not only have the economic benefits of TTIP have been overstated, it will additionally put downward pressure on regulation in sectors such as health and the environment and poses a significant threat to national democratic decision-making.

Worryingly, moves by a future democratically elected government to put the deregulation process into reverse and bring our public services – including our NHS, railways, water, energy and other utilities – back into public ownership would be confronted by an international court system (ISDS) where lawyers will judge what is or is not a barrier to “free trade”. And it will be carried out behind closed doors. Corporates can go on to sue nation states that stand in the way of “free trade” and threats to future as well as actual losses to profits.

In August 2014, Labour MP Katy Clark urged David Cameron to stop the EU-US trade pact from opening more public services to the private sector.

The Transatlantic Trade and Investment Partnership (TTIP), which has remained under negotiation behind closed doors, “would let companies sue if national governments pass laws that hurt profits,” Ms Clark warned.

This is bad news for our existing public services such as the NHS, or other services that we may wish to take back into public ownership such as the railways.

“Private companies already run certain services but under the new plans the government would never be allowed to run these again, as doing so would hurt the profits of the companies involved.”

Since discussions on the content of the Treaty have remained secret, its exact content is unknown, (including to the Labour Party) but private firms on both sides of the Atlantic are keen to use competition rules to force open what remains of the public sector.

During a parliamentary debate in February, secured by back bench Labour MP John Healy, Labour MPs, including Katy Clark, raised many concerns about the TTIP.  Jeremy Corbyn said: “Why is there such secrecy surrounding the negotiations? Why are not all the documents on the table? Why are the demands made on European public services by the American negotiators not made public? Why are not the demands made in the other direction also made public? I suspect that, if the agreement ever comes to fruition, every Parliament in Europe and the US system will be presented with a fait accompli: they will be told that they have to accept it.”

Ian Lavery  commented: “A number of people have said that there must be a good business case for the transatlantic trade and investment partnership. I think that we need much more than a good business case. I am concerned that there are huge inherent dangers in the TTIP for many working people and for public services in the UK. My major concern is that the trade agreement has the potential to dilute workers’ rights.”

Katy Clark, the North Ayrshire and Arran MP, wrote to the Prime Minister urging him to protect public services and pointed out that France won the right to continue supporting its film industry and that the US had blocked any deal on its finance sector.

She said: “If the leaders of these countries can protect what’s important to them, then David Cameron can do the same for Britain.”

Neil Clark from the Campaign for Public Ownership, said the Labour MP’s warning was timely as people had “still not woken up to the consequences of TTIP.”

“It is fundamentally undemocratic, since though large majorities of the public are in favour of renationalising key services such as the railways or energy, subsequent governments would be unable to do so without breaking the terms of the pact.

“But it would impose privatisation forever and must be stopped in its tracks.”

Angela Eagle said: “I know that following widespread public concern, the European Commission halted negotiations on the investor state dispute settlement (ISDS) section of TTIP pending the outcome of a public consultation. I appreciate that there are serious concerns about the potential impact of the ISDS provisions and I hope that the European Commission will consider the responses to this consultation carefully.”

In November last year, Labour MP Clive Efford, with the backing of the party’s leadership, called for the exemption of the NHS from the trade deal. It was a victory for the Private Member’s Bill to repeal the Tory privatisation of the NHS and Exempt the NHS from the TTIP Agreement. Mr Efford said: “The Bill will not save the NHS overnight – only the election of a Labour government can do that. But it does give all MPs the opportunity to accept that the 2012 Act has been a disaster and to begin to create an NHS which puts patient care at the centre of all it does, not private profit.”

Andy Burnham, the shadow Health Secretary, claimed that signing TTIP could jeopardise the founding principles of the health service. The many critics of this trade agreement fear that the deal would leave the NHS vulnerable to takeover by American healthcare giants and undermine the principle of a service free at the point of delivery.

Joan Walley MP, chair of the Commons Select Environmental Audit Committee (EAC), which launched its inquiry on 8th January, said: “We will be investigating whether it really is possible to sign such a deal and at the same time safeguard European environmental standards, as negotiators have claimed.

Greater transatlantic trade and investment could be beneficial for Britain, but we must monitor these talks carefully to ensure they are not trading-in the rules that keep our food and environment safe.”

A recent report from the Center for International Environmental Law (Ciel) argues that the European chemical industry wants the US system of chemical risk assessment to be adopted, which the group says would allow the use of over 80 pesticides currently banned in the EU. Other campaigners say US biotech companies want to use TTIP to open EU borders to imports of genetically modified food.

Samuel Lowe, from Friends of the Earth, said: “With the potential for essential environmental and food standards to be discarded as ‘trade irritants’, the TTIP presents a unique challenge to the health of our environment. The EAC should scrutinise the proposals and ensure that these serious concerns are no longer brushed under the carpet.”

Absolutely. Labour has said very clearly that they won’t back this Treaty unless the NHS and other key public services are excluded. The crucial inquiry, which Labour MPs have called for is welcome. It`will focus on the potential environmental impacts in the UK of TTIP, including through changes to regulations and product standards and the operation of an “inter-state dispute settlement” regime; and on the potential effects on developing countries. Gathering evidence is an essential when it comes to the process of agreeing, formulating or rejecting policies

 

Further reading:

The coming Corporatocracy and the death of democracy

Just what will TTIP mean for our jobs, environment, consumer rights – and publicly provided health service?

Lord Howe said we couldn’t exempt the NHS because it would place our pharmaceutical companies at a disadvantage.

If we don’t do something about the TTIP it may be all of us who will be at a disadvantage.

And one thing which is clear is that the TTIP will open up the NHS to American private health companies.”

There are some things we just can’t afford to risk – and the NHS is one of them.
Andy Burnham has already been to Brussels to discuss NHS exemptions.
Labour is committed to them.

“The report – on the workings of NAFTA – the North American Free Trade Agreement – which has been around for 20 years suggests we may need to go further – and we certainly need far more open discussion of what’s at stake.

This is something the LibDem/Tory Coalition seem very reluctant to have.
Could the pattern of funding of the Tory party have anything to do with that?

We merely ask.” – TTIP/ EU-US Trade Agreement – you can’t trust the LibDem/Tory Coalition with the NHS Alex Sobel MP

 

Pictures courtesy of  Robert Livingstone

Tory dogma and hypocrisy: the “big state”, bureaucracy, austerity and “freedom”

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The Tories are not “paying down the debt” as claimed. They are raising more money for the rich.

Labour’s social and economic policy was a success, and this is substantiated by the LSE’s definitive survey of the Blair-Brown years:

There is clear evidence that public spending worked, contrary to popular belief.” Nor did Labour overspend. It inherited “a large deficit and high public sector debt”, with spending “at a historic low” – 14th out of 15 in the EU.

Labour’s spending increased, and money was invested in public services and social programs, and until the crash was still “unexceptional”, either by historic UK standards or international ones.

Until 2007 “national debt levels were lower than when Labour took office”. After years of neglect during the previous Conservative administration, Labour inherited a mess: public services in very poor state, shabby and squalid public buildings and unforgivably neglected human lives that formed a social deficit much more costly than any Treasury debt.

Labour Ministers set about addressing the causes and devastating effects of poverty and social marginalisation. Both poverty and inequality had risen to levels unprecedented in post-war history. This process accelerated during the 1980s.

Unlike every other post-war decade, in which the benefits of economic growth had been shared across social groups, the economic gains of the 1980s disproportionately benefited the rich at the expense of the poor (Hills, 2004). Social inequality on such a gross level was not only the result of Thatcher’s policies, she celebrated it. She declared that inequality is essential to fostering “the spirit of envy” and hailed greed as a “valuable spur to economic activity”.

The mess that Thatcher left is verified by several longitudinal studies. Dr. Alex Scott-Samuel and colleagues from the Universities of Durham, West of Scotland, Glasgow and Edinburgh, sourced data from over 70 existing research papers, which concludes that as a result of unnecessary unemployment, welfare cuts and damaging housing policies, the former prime minister’s legacy

includes the unnecessary and unjust premature death of many British citizens, together with a substantial and continuing burden of suffering and loss of well-being.

The article also cites evidence including the substantial increase in income inequality under Thatcher – the richest 0.01% of society had 28 times the mean national average income in 1978 but 70 times the average in 1990, and the rise in UK poverty rates from 6.7% in 1975 to 12% in 1985.

It concludes that:

Thatcher’s governments wilfully engineered an economic catastrophe across large parts of Britain” by dismantling traditional industries such as coal and steel in order to undermine the power of working class organisations, such as unions. This ultimately fed through into growing regional disparities in health standards and life expectancy, as well as greatly increased inequalities between the richest and poorest in society.

Blair established the social exclusion unit inside No 10. “Social exclusion” signified not just poverty, but its myriad causes and symptoms, with 18 task forces examining education, babies’ development, debt, addiction, mental health, housing and much more. Policies followed and so did improvements.

John Prescott’s department published an annual Opportunities for All report that monitored these social targets: 48 out of 59 indicators improved. So when Cameron and his band of brigands sneer that “all Labour did was give tax credits to lift families just over the poverty line” – “poverty plus a pound” – they lie through their teeth.

Contrary to Tory claims, benefits were not Labour’s main instrument of social change: the benefit budget fell as a proportion of spending, outstripped by increases in health, education and other social services.

Labour policies enshrined principles of equality and inclusion. The Tories deplore such principles, yet that doesn’t stop them claiming that their socially regressive policies are somehow “fair”. Things got better with a Labour administration, money was mostly well spent. That’s not the case now. It’s all being intentionally and spitefully undone. We are moving backwards on just about every positive social measure Labour put in place: the coalition’s “more for less” is exposed as pretence. They are simply raising more money for the rich.

And all because of their driving ideology. George Osborne’s “plan A” isn’t about economics: it amounts to little more than a rehashed Thatcherite ideological agenda of deregulation and labour market “flexibility”, as modelled by the Beecroft report – the assault on the rights of employees, and Labour’s historic equality legislation. The Tory demand for a “nightwatchman state” is both ill-conceived and completely irrelevant to Britain’s economic circumstances.

The Coalition have borrowed more in 4 years than labour did in 13 and have NOTHING to show for it except a handful of wealthier millionaires. And the return of absolute poverty.

We know that austerity was intentionally imposed by the Coalition, using a feigned panic over the budget deficit to front an opportunistic vulture capitalist approach to stripping our public assets. With the Coalition in power for 4 years, the deficit has apparently receded in importance.

We can hope that Labour can return to its  pro-social role of advocating government spending for the provision of public services. Conservatives have always played on dogma and popular prejudice by constantly equating government with bureaucracy. But that’s just the superficial excuse for their obsession with removing every trace of supportive provision and our public services.

It’s more accurate to say that Conservatives equate socially responsible, democratic, caring governments with “bureaucracy”. Conservatives aren’t ever interested in championing independent and merit-based public service. But most criticisms of government bureaucracy are based on myth, not reality.

The agencies that the Tories attack and destroy actually play a valuable and indispensable role in making our society a better place to live. They are the very hallmarks of what makes us civilised, they are how we support the vulnerable, ensure equal opportunities, uphold human rights.

The whole point of having human rights is that they apply to EVERYONE – something the Tories never understand – if rights are  not universally applied, then they are worthless. In fact they are hostile to the very notion that we each have equal worth, as we know.

Tories value and develop social hierarchy. When Tories want to make “shrinking” government sound attractive and feasible, they claim they are cutting “bureaucracy” and not social “programs.” Most people recognise the public value of State programs – in the areas of education, health and the environment for example – and don’t want to see these reduced; but everyone hates bureaucracy.

Using the term “bureaucracy” in this way is a rhetorical sleight-of-hand that attempts to obscure the real costs of cutting back on government programs. The lack of coherent reasoning underpinning the rhetoric is because this is simply Tory fundamentalism: it is not founded at all on rational, evidenced discourse.

I’ve said elsewhere that Edwardian levels of inequality led to the Great Depression. Austerity measures under Chancellor Hindenburg contributed to the rise of Nazism. The drop in household income in Japan between 1929 and 1931 led to a wave of assassinations of Government officials and bankers.

Social policies after World War 2 turned the tables and brought peace, with inequality steadily dropping in Britain until recently. But inequality is now returning to pre-war levels. The Tories are incapable of learning from historic lessons, because of their own ideological bondage.

In response to the atrocities committed during the War, the International Community sought to define the rights and freedoms necessary to secure the dignity and worth of each individual. Ratified by the United Kingdom, one of the first countries to do so, in 1951, those human rights originally established in the Universal Declaration have been steadily eroded since the Coalition gained Office.

There’s a clear link between high levels of inequality and failure of Governments to recognise human rights, and to implement them in policies. Authoritarians view the rights of the individual, (including those considered to be human rights by the international community), as subject to the needs of the Government. Of course in democracies, Governments are elected to represent and serve the needs of the population.

Democracy is not only about elections. It is also about distributive and social justice. The quality of the democratic process, including transparent and accountable Government and equality before the law, is critical. Façade democracy occurs when liberalisation measures are kept under tight rein by elites who fail to generate political inclusion.

How remarkable that a government that argues against bureaucracy on the grounds that it’s a “threat to individual freedom” have no problems imposing the Gagging Act and the Legal Aid Act – policies purposefully designed to severely limit our freedoms. But then, the Tories were never known for their rationality and joined-up thinking. Or for integrity and telling the truth.

Related articles:

Thatcher’s secret plot to dismantle the welfare state and privatise the NHS revealed

The mess we inherited: some facts with which to fight the Tory Big Lies

The great debt lie and the structural deficit myth

Osborne’s real aim is not budget surplus, but attack on Welfare State & public sectors 539627_450600381676162_486601053_n (2) scroll2 It’s not a difficult task for a government to guarantee a safety-net that is always available for anyone who falls on hard times during an era of huge social and economic change. We all fund it, after all. And we all know that unemployment, injury or illness may happen to anyone through no fault of their own. It’s considered a duty of any first-world government to provide the means of basic survival for its citizens and to fund that with the money we contribute via taxes. In fact such an approach to social and economic welfare is internationally codified in human rights.

Article 25 of the Universal Declaration of Human Rights, to which the UK is a signatory, reads:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

The Tories prefer to spend the tax they take from you on Tory donors – private companies that don’t deliver a service but simply fleece profit; on undeserving millionaires’ tax breaks – the feckless, scrounging rich had at least £107,000 each per year extra already. Then there is the never ending list of Tory expense scandals – all at our expense. And tax evasion. Why are we paying for this?

Furthermore, why are we indifferent as a society to the fact that our government is causing harm to our fellow citizens? I can’t comprehend this, how can we have allowed this to happen, as a so-called civilised and once democratic society? It’s about a driving ideology that is socially detrimental, malevolent, and not economically necessary: the Tories do not think that people have a right to food, housing or medical care, that much is clear. But they continue to take the money we have paid since the 1940s for those things. And hand it out to the wealthy.

Despite these facts, the Govt and the right-wing media have the audacity to talk about welfare claimants, as if all our woes are their fault. They aren’t, the spiteful authoritarian Tories are the problem.

We can’t afford this government, economically, socially, morally or psychologically. Osborne’s austerity message was seriously undermined, and his lies in trying to blame the last government were demonstrated last November when the Office for National Statistics found that the coalition had borrowed £430.072 billion since it took over, whereas the last Labour government managed to borrow just £429.975 billion in 13 years. –  George Osborne Says Britain’s ‘Best Days Lie Ahead’, Ignoring These 6 Graphs 1234134_539964652739734_1075596050_n

Many thanks to Robert Livingstone for his brilliant memes